Crap, pure and simple. Recording telephone conversations? I can't imagine any doctor or patient agreeing to that. The potential for misuse is too great, regardless of whatever "crucial protections and restrictions" might be put in place.

5:24 pm March 23, 2011

Anesthesiologist wrote :

The paper cited here is behind the times. Most of the behaviors described have been a part of the practice where I work for years. The aviation analogy suffers from several differences that makes the direct translation of aviation safety practices difficult or inappropriate:
- The setting where the analogy works best is the operating room which represents the most controlled environment in the hospital. As you move away from this setting toward ordinary wards and outpatient clinics, the analogy is harder to make.
- The differences between patients in physiology and how they respond to treatment is something that pilots do not have to deal with--one 737-800 will handle much like another. Tightly coupled checklists and forcing functions can only go so far when dealing with this variability. Then there is the problem of complications. Despite everyone's best efforts, bad outcomes and "never events" can still occur. The aviation analogy falsely holds out the hope that safety can be raised to the point where health care can be delivered with practically zero risk.
- Unlike aviation where time is built into the system for completing safety-related tasks, many healthcare settings do not lend themselves to hitting the "pause" button. Safety procedures that slow the system below what's needed to keep up with patient flow are ripe for work-arounds to bypass the safety mechanisms.
- When talking about flattening the hierarchy, both the captain and the first officer of a commercial aircraft are qualified to fly the aircraft. There are differences in experience and responsibiltiy between the two but they are both trained to do the same job. In healthcare, the flattening concept starts to break down when it is extended to staff with different professional backgrounds. I have seen it used as justification for nonphysicians to inappropriately challenge medical decisions and be disrespectful toward physicians. Staff members should feel comfortable contributing to the overall solution but they also need to know their role.

5:37 pm March 23, 2011

Skeptical Scalpel wrote :

I have no problem with most of these proposals, many of which we are already doing. I agree with Dr. Dredd that recording phone conversations is not only unlikely to be agreed upon, it is highly impractical. Who would monitor them? Who would have access? How long would they be kept?

The first-name only suggestion is also OK with me. But it will require a major culture change. And, the operating room differs from the cockpit in that many times a surgeon's "co-pilot" is a very junior surgeon or a surgical resident, unlike an airplane co-pilot, who is a fully trained pilot.

I love the black box. But the phone conversations is not the example I would use. A data library in chronological order from ALL devices (oh the things we could learn/prevent). Now my outcomes, quality and infection control friends you can do your happy dance. My attorney, risk and physician friends...think about it.

6:41 pm March 23, 2011

Medical Necessity wrote :

I think that some intelligent level of tort reform would help mitigate some of the concerns...

9:58 pm March 23, 2011

Doctor Zhivago wrote :

The ambiguities of patient safety amidst the patient's diseases far exceed the issues of airline function and safety. Nevertheless, one conclusion is of merit: "'The benefits from introducing any patient safety initiatives need to be tested against the benefits of other forms of health care, as well as their costs,' they write."

Regrettably, the HIT devices have never been tested for benefits in overall outcomes and have zero uniformity (except for uniformly meaningful poor usability) yet they are being sold as if they are safe and efficacious.

On that subject, the report contained herein is relevant to the U Michigan Milbank Quarterly report

It is analyses such as these that avail to the safety detail of aviation, but, was never done in the US for HIT devices, costing $ billions and lives.

10:21 pm March 23, 2011

docL wrote :

The real difference is in self reporting errors and dealing with mistakes. The punishment has been dissociated from confessing error in aviation. Medical quality assurance occurs in an environment where hospital privileges or even licensure can be lost, so everyone fears and loathes it and learning and re-education are minimized.

12:16 am March 24, 2011

omg wrote :

hopfully with more rules and protocols we can make medicine as safe as say avation and even nuclear power plants, because checklists can prevent all problems.

They would never allow a pilot to fly a jet whose engines and fuselage have not been thoroughly tested for defects, yet the government is coercing doctors and nurses to deploy and use equipment for patient care that, according to the information above, is unsafe, putting millions of lives at risk.

This has nothing to do with monitoring telephone calls or check lists or rocket science. This is HIT 101 in the freshman year. The government and the HIT industry gets an "F".

11:42 am March 24, 2011

Marco Huesch wrote :

I agree with all of Anesthesiologists' points and raise a related one:

In aviation, I understand, there's little disagreement about what to do in almost all situations. A plane is a plane, and gravity is gravity, and there's not a lot of acceptable options even when birds hit your engines.

In medicine, there's a wide range of acceptable treatment options for many conditions, and the science doesn't always guide us as providers or patients as to what's best. Treatment guidelines leave large margins where provider discretion is the rule. Clinical trials start by assuming that the different treatments are similar in likely effect, or it wouldn't be ethical to enroll and randomize patients.

So the aviation-healthcare analogy works really well at the back-end, in the OR with standardized procedures, but has much less to offer when it comes to deciding between surgical and medical treatment for some diagnosis, and even less to offer when it comes to making a diagnosis at the front-end.

Pushing analogies past their breaking point seems something I'd put high up on a checklist!

9:13 pm March 24, 2011

Does every plane crash wrote :

Great analogies between surgery and flight except for one little, tiny difference--every patient is going to 'crash' and die. Will every plane crash?

I see bureaucrats trying to sell their ideas with catchy slogans and comparisons. It is an insult. Even more sad, the physicians don't even realize how manipulated they are because the profession is rampant with self-immolation.

12:44 am March 25, 2011

Retired physician... wrote :

Aviation's F.A.A.. review techniques of accidents and "near misses" might help loss management analysis in medicine be it surgery or the other aspects of health care. The aversion of some commentators to "black box' retrospection is peculiar as it was long ago studied and confirmed that patients routinely fail to recall what they are told by clinicians thus perhaps the techniques of these critical encounters could be standardized in more effective manners.

Also a study years ago showed that even P.B.Brigham Hospital staffers and support staff registered less than a 60% adherence rate with prescribed therapy thus those elite suggest that patients are somewhat at fault in the less than desired outcomes and this too warrants study. Lastly the recent use of "pit crew" hand-offs of post-op cases to S.I.C.U. cases has shown that there is room for change in the medical "practice" of intensive cases in our hospitals.

"Work smarter not harder" is better than "Think, there's got to be a harder way to do this...". Let's stop the defensive posturing and the personality driven success models and standardize the best of what is done so that the future physicians can be nudged into the best behavior patterns. We train the best physicians in the world. Now we need a Demming to lead us in training them to manage and produce efficiently. If we don't someone else will and we will forefit yet another asset that has made our Republic a beacon of progress for mankind.

11:46 am March 25, 2011

yes,doctor. wrote :

Disrespectful to physicians? Really,Anesthesiologist.
I believe you mean somehting more like "Know you place, boy".

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